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Home My WebLink About0020 HAMDEN CIRCLE - Health ao Aana� c.«, ,.�.,,,��5 aq� - i sc. f NA •ONI1trN 9-389K'ON tisccL adn ® IlII i a' I e K i S,�w L LOCA J104 SEWAGE PERM1 , NO. Z--&�4- Z f 3 04 VILLAGEf_/�G INSTA_LLER'S NAME & ADDRESS G 412C-d(7 B U I L D E R OR OWNER 4,:�a .44 ga DATE PERMIT ISS.0 E D DATE COMPLIANCE ISSUED 'z 71 t t n No......... .:� :... , F�s....2.:......J�.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH :. /7 G.. _-y .........OF....... e... - Appliration for Dhipusa1 Workti Tontitrnrtinn ramit Application is hereby made for a Permit to Construct t� or Repair ( ) an Individual Sewage Disposal System a . 2 4 ..... - - � 1 •••. ---•-.-•-- • ---.----- ----------------------- ... Location- ddr ,,i_/ . or Lot No. er Address =_.�� ---- - - ----.---- . ...................••-•. Instalier Address UType Building Size Lot__/P ......Sq. feet Dwelling—No, of Bedrooms-----------.-- •......................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building '........................ No. of persons Showers Cafeteria Wf� Other—Type g --'- P ( ) — ( ) d .Other fixtures -- -- ------------------------- - w Design Flow----------------____.. gallons per person per day. Total daily flow._____._. __ gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.........._'....... Total Length...........!... Total leaching area............_.......sq. ft. Seepage Pit No....... .......:. Diameter. Depth_. Depth below inlet.... Total leaching area �._.�7�sq. ft. Z Other Distribution box ( ) Using to ( ) `-' Percolation Test Results Performed b y , _ Date.... __ tO `— ,� Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ G14 Test Pit No. 2................minutes per inch Depth of Test Pit....... ------------ Depth to ground waterA/a __ - Description of Soil__ _____ . _ A x r ; � - - w UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of IITL!Z- 5 of the State Sanitary Code— The undersigned further, rees not to place the system in operation until a,Certificate of Compliance has been ' sued by the board - ealt ,� A Signed.... ••.: Date Application Approved By............................... _____ __ -----•----------........ ....................Da Application Disapproved for the following reasons:................................................................................................................ --------•••••-••••••••-••----••--••---•---••-•-••-•-•--------••••••••.••-----•-•--......-•----•••-•-•-••-••-••--._.._...•-••-•--•-------•--•-••-••-------•----•-•-••••--•----•-----•---•-•--••••-•••--. Date �. Permit No......................................................... Issued---...- __- d � Date .n THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Tnnstrnrtinn rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage,Disposal System at - w- --- - .._. .. .............................................. A!� oAti n-Iddre �Jspy �/`Jorr Lot No._._.T(j Cam. .......................... 'Gr..... G � .... Owner 11 Address W Installer Address Pq Typ cf Building Size Lot.../ 6k410 . Sq. feet Dwelling—No. of Bedrooms-__....t.............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building o. of persons...... Showers ( ) — Cafeteria ( ) d Other fixtures = -------- --- - - W Design Flow.............. ....._____gallons per person per day. Total daily flow._._......_, ..............gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter-.............. Depth................ Disposal Trench—No. .................... Width o..........�.!... Total Length.........I.._..//Total'leaching area....................sq. ft. Seepage Pit No-------/----------- Diameter.. -,,r-.-_- Depth below inlet ----6�--•--____ Total leaching area_,fq. ft. Z Other Distribution box (4)- Dosing tank ( ) Percolation Test Results Performed by.. ,/1 . . ....... Date......./47:"•-_--�--.� aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit_................... Depth to ground water,/�� 04 . -•-••- •--•• ......... . •--• /t • . ---•_. ..- • .............................. 0 /Description of Soil......... . ---- / - --. { 000;x ---------------------------------------------------•-•••••--------••-•-••------•----•-••-••-•-•-•-•---•------•-••--••--•-•---•---•-•••-••-•--------•-•••••••••-•••••••-•-•••-.....-•-•••......-••-•-•. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•------------------------------------------------•----•--•--------------------••••.....-•-........----_-• .................................................-.......................................... Agreement: The undersigned agrees to installs the aforedescribed� Individual,Sewage.Disposal System in accordance with the provisions of TI'1E 5 of the-State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is tied by the board of healtl. Signed•• ....... ✓"�fir ey{ Application Approved By........ .------•--•--------.=••-•...._•--••-•--•-•-•-•-- Date Application Disapproved for the following reasons-.......................................... ------------------------------------------------------------•----•-------••------•---........----------...---------------•-----------------------------------------------------......................... Date Permit No.......................... Issued • � Date THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALT ..........OF...... ... .................. ......... ..... ......... ................... Trrtif ratr of firont'litanrr THffl IS TO CERTIF That the `$di e Disposal System constructed (,�,4-or Repaired ( ) by.. - ......................................................-•--•--•-•-•----•.........•--- ----- •••_•Inst ler at / has been insta led in accordance with t e provisions of TI' s 5 of The State Sanitaryi de as described in the application for Disposal Works Construction Permit No I....•... .................. dated_. :�j` f7r'�y' •-------- THE ISSUANCE OF THIS CERTIFICATE SHALL O'�`BE CONSYRIIE® A AARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ...."....'.. a .._ -•-•-- Inspector_..._.DATE........... . :...... . �/ THE COMMONWEALTH OF MASSACHUSETTS BOA4;D OF HEALTH .�_....Disposal We,'e ks Tottf rndion rrm Permission is hereby granted..._ to Construct ( or Repair ( an Individual Sewage Disposal System atNo..,�. ;a�'� - - ,. -- ------------------------------------------------------------------- - ------------- yr�� -� "? '4 Street as shown on the application for Disposal Works Construction Permit No.............. .... Dated_._ �yf_l_�70�,._. /'�r4 f r ' DATE.......................... 7; ................... --- FORM 1255 HOBBS_& WARREN, INC.. PUS ISHERS -A - - ._,a.•_ ,-.-a��.,�-r '.-syn „ter, ---- ----�" -__._,__.,__._. _ - �. _. _,. _._ -- _ _ _. .,. .- _ _ -- - --. _ _ • �6Lfl�+ c Fl�rrsw GQADE•/ X Ft/v4SM C Ave 1=►N/i`!1 GSAfl� - ----` GwER Ti4 NK : law C OvER ,O/r : t2 X a To aFFavnrt7. L-LE✓.r �4x2 � 40G t .. / CIS//ivNE�✓�Cocdc 1 \\ - N G �/ cwvl�t �ElDED G�9CAC DyvEL,.C.tN G _.'- - •.�� ----._._._ � ..�G� . - _fi hl`G 3-oiASri.rE O Q / ' � ,'� 1eC�!N Fbx'GED CONG• ,. .� �� / � O O � O � G.�d�NE'O S'TON,� O . o o o d / 0 g o 0 0 .SEPTIC 7 AW K - ►o t3E LE�.Et< '� , AND .5 0,62 e / a O a o a / t a 0 A907 VAI OOr P1r 3X7 -/VaT To FCAG E 8- Lfr9 cN1 NG P/7' DES I Gam/ CR/ TERM GAL• PE•2 vqy = �ZO To rA L t�.4�G y FLa6�= 22� L"AC N ING AeeO'? P.Pe V11>Ah s E Wht. 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